Shifting the focus from weight to health

It was a packed room at the Grand Rounds session when Dr. Leora Pinhas made her presentation on living in a weight and shape focused age.  Prepared to challenge long standing beliefs about weight, Dr. Pinhas reminded the group that strong beliefs about anything are hard to shift.

She went on to highlight the concept of risk, explaining that risk is oftentimes difficult to interpret and manage. “While gaining weight is often believed to be the riskiest thing you can do in North America, there might be other factors at play,” says Dr. Pinhas.

Risk, she explained is dependent on your perception and the context in which it is being discussed. Very often statistics which identify a situation as being risky doesn’t reflect the reality.

“The statistics will often report that an incidence has tripled, thus making it sound very risky.  In reality, it may have just moved from 3 – 9 percent.  In this case, the remaining 91 percent (down from 97 percent) remain not at risk.”

Dr. Pinhas also highlights that in examining the statistics reported about weight, it is important to note the difference between correlation and causation.  “It is often reported that the fatter you are, the more likely you are to die, which doesn't necessarily mean that being fat causes death.  There are other factors that may be related.”  For Dr. Pinhas it was clear in this case, that being fat is a correlation to death but not necessarily a cause.

“You can’t tell how healthy someone is by their weight.  There are a number of other factors that determine how healthy you are,” clarifies Dr. Pinhas.

In fact, she explains that people in the overweight category according to their body mass index (BMI) are living the longest. “The BMI range was redefined in 1998 moving the healthy range down from 28 to 25, thus redefining millions of people from being healthy to overweight overnight, “ says Dr. Pinhas.

While not disagreeing that there is a correlation between a high BMI and a higher incidence of death, she emphasizes that there are other factors that impact this.  “People with higher BMIs tend not to exercise as much and tend not to eat properly.  It is these factors that may be affecting their mortality,” she says. 

In navigating through a weight focused world, Dr. Pinhas suggests that the focus on modifying weight may not be as effective as modifying behaviours, in order to be healthy.

The drive to be healthy is often affected by the stigma associated with what is thought of to be too fat or too thin.  This stigma influences how people at a certain weight are treated.

“In this weight focused world, there are certain cultural biases against obesity which are wide spread and on the increase.  It affects how we treat people.  We often tell someone who has an eating disorder, and reports to the hospital for a medical condition to go home and eat something and then come back.  We wouldn’t say to someone who is presenting with chest pains ‘you are smoker, go home and come back when you have stopped smoking,’” says Dr. Pinhas.

Weight bias also has a significant impact on the mental health of those who experience it, often resulting in anxiety and depression. 

‘It is true that being thin, beautiful, tall and attractive gets you further in this culture and it often means that there are a lot of people on diets, which don't work because weight is often genetically determined and the body has a strong drive to defend its weight,” adds Dr. Pinhas.

Passionate in the desire to help others rethink the focus on weight and body size, Pinhas reflects that this is a factor that we can have an impact on by changing the way we think.